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In-hospital do-not-resuscitate (DNR) orders in the State of Texas have faced much tighter regulation since April 2018. With Senate Bill 11, both the meaning of a DNR order and the circumstances in which it can be entered are now more tightly defined.
In-hospital do-not-resuscitate (DNR) orders in the State of Texas have faced much tighter regulation since April 2018. With Texas Governor Greg Abbott signing into law Senate Bill 11, both the meaning of a DNR order and the circumstances in which it can be entered are now more tightly defined. Before the introduction of SB 11, it was technically possible for a physician to enter a DNR order without a patient’s or surrogate’s consent. But now physicians must be careful to ensure that their patients meet certain criteria to avoid being at legal risk for criminal misdemeanor.
Important aspects of this law include who can enter the order and how the documentation of this emotion-laden decision must be carried out. Of particular impact to teaching hospitals across the state is the mandate that DNR orders be entered by attending physicians only. Most orders have been written for patients by trainees of various levels or advanced practice providers; attending physicians now must be the ones to write the orders, although the repercussions of others entering the order are vague.
One of the more serious changes, one that will impact both physicians and families, is the new requirement for a written and dated directive from either the competent patient him-/herself or a surrogate decision-maker on the patient’s behalf. Patients or their family members are expected to sign the document affirming their decision for DNR status, which may elicit even more emotion at a time when an already difficult decision is being made. There is no requirement for a written directive from pediatric patients.
SB 11 dictates that, for a DNR order to be valid, it must be in compliance with certain criteria, some of which are:
Posted: 10/7/2019 | 0 comments
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